1. DEADLINE for scholarship applications is Thursday, April 20, 2017, 5:00 p.m. (no exceptions). 2. Refer to criteria below for eligibility requirements. 3. Refer to application process below for a list of the supporting documents needed (i.e., reference forms, evidence of GPA, etc.) Incomplete applications will not be considered. 4. If any question does not apply to you in this application please put N/A in the space. 5. Type or print legibly. 6. Recipient(s) will be named during the Honors Program in May 2017. 7. If you have any questions about the application, please email us at kiester.bftc@gmail.com NOTE: Scholarship funds will be awarded to the student upon evidence of registration in an accredited postsecondary institution second semester of their freshman year. Purpose: To Provide scholarship(s) to deserving USC high school graduating senior(s) interested in or intending to pursue post-high school course of study at either college/university or other post-secondary educational institution. Award Components: $3000 in scholarship(s) and individual certificate(s) will be awarded to student(s) selected by the Kiester For A Cure/Lori A. Schumann Scholarship Committee. Criteria: 1. Applicant must be a USC student. 2. Applicant must be a graduating high school senior in the year of the award. 3. Applicant must demonstrate positive-impact involvement in the complete sense consistent with capacity and circumstances and/or significant improvement/success in scholarship and community involvement, determined through letters of recommendation. Application Process: Applicant must submit the following items: 1. Completed application form (if handwritten, please print legibly) 2. Letter of application addressed to the Scholarship Committee. The letter should contain a brief explanation of career goals and biographical (background) information. 3. Three (3) letters of recommendations from choice of high school teachers, administrators, counselors, employers, or individual with significant knowledge of applicant s experience and involvement. 4. An official and recent high school transcript with cumulative grade point average and a class standing/rank. 5. Personal Essay. In your essay, please answer the question on the enclosed essay form. How have you made a positive difference? Deadline for the application is Thursday, April 20, 2017. Applications postmarked after this date will not be considered. Please mail application to: Kiester For A Cure Lori A. Schumann Scholarship Program PO Box 133 Kiester, MN 56051 1
Please type or print your answers. If application is illegible it will be returned to you. 1. Last Name: First Name: 2. Mailing Address: Street: 3. Daytime Telephone Number: ( ) City: State: ZIP: 4. Date of Birth: Month Day Year 5. Current High School: Number of years attended: 6. I will be attending the following school in the Fall of 2017: Expected cost of tuition and housing: Proof of current student enrollment is required prior to receipt of funds. (Jan. 2018) 7. Grade Point Average (GPA): (On a 4.0 scale) Attach proof of GPA. Your most recent official school transcript required. 8. Name & address of parent(s) or legal guardian(s): Use reverse side of application if you need more space. Name (s) Street: City: State: ZIP: Home phone of parents or legal guardians: 9. Name and city of other high schools attended: Number of years attended: 10. What specialty/major do you plan to major in as you continue your education? 11. What are your educational and professional goals and objectives? 2
12. List your academic honors, awards and membership activities while in high school: 13. List your community service activities, hobbies, outside interests, and extracurricular activities: 14. Special Consideration (can include some of the following: death of a student s parent or guardian; disability of student; other unusual expenses or circumstances) 15. Personal Essay Please answer the following question: How have you worked in your life to make a positive difference? Submit your response on the last sheet provided with this application. 16. A. The following items must be attached to this application in order for the application to qualify to be reviewed by the scholarship committee. B. Your application will be returned to you if these items are not attached to this application. (No exceptions.) C. Circle YES or NO to be sure you have attached each item as required. YES NO Three (3) reference forms. Return these completed forms in a sealed envelope from your teachers. YES NO Proof of college acceptance or current student enrollment. A letter of college acceptance or program acceptance is required for receipt of funds. YES NO Most recent official high school transcript. Photocopies of your transcript are not acceptable. YES NO Personal Essay. How have you made a positive difference in your community, school, family, etc.? 3
STATEMENT OF ACCURACY I hereby affirm that all the above stated information provided by me is true and correct to the best of my knowledge. I also consent that my picture may be taken and used for any purpose deemed necessary to promote KFAC s/l.a. Schumann Scholarship Program. I hereby understand that if chosen as a scholarship winner, according to Kiester For A Cure policy, I must provide evidence of enrollment/registration at the post-secondary institution of my choice before scholarship funds can be awarded. Signature of scholarship applicant: Date: REMEMBER The deadline for this application to be received by KFAC is April 20, 2017, 5:00 p.m. No exceptions! 4
How have you made a positive difference? Personal Essay 5